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As an advanced practice nurse assisting physicians in the diagnosis and treatment of disorders, it is important to not only understand the impact of disorders on the body, but also the impact of drug treatments on the body. The relationships between drugs and the body can be described by pharmacokinetics and pharmacodynamics.

Pharmacokinetics describes what the body does to the drug through absorption, distribution, metabolism, and excretion, whereas pharmacodynamics describes what the drug does to the body.

Photo Credit: Getty Images/Ingram Publishing

When selecting drugs and determining dosages for patients, it is essential to consider individual patient factors that might impact the patient’s pharmacokinetic and pharmacodynamic processes. These patient factors include genetics, gender, ethnicity, age, behavior (i.e., diet, nutrition, smoking, alcohol, illicit drug abuse), and/or pathophysiological changes due to disease.

For this Discussion, you reflect on a case from your past clinical experiences and consider how a patient’s pharmacokinetic and pharmacodynamic processes may alter his or her response to a drug.

To Prepare

• Review the Resources for this module and consider the principles of pharmacokinetics and pharmacodynamics.
• Reflect on your experiences, observations, and/or clinical practices from the last 5 years and think about how pharmacokinetic and pharmacodynamic factors altered his or her anticipated response to a drug.
• Consider factors that might have influenced the patient’s pharmacokinetic and pharmacodynamic processes, such as genetics (including pharmacogenetics), gender, ethnicity, age, behavior, and/or possible pathophysiological changes due to disease.
• Think about a personalized plan of care based on these influencing factors and patient history in your case study.

By Day 3 of Week 1

Post a description of the patient case from your experiences, observations, and/or clinical practice from the last 5 years. Then, describe factors that might have influenced pharmacokinetic and pharmacodynamic processes of the patient you identified. Finally, explain details of the personalized plan of care that you would develop based on influencing factors and patient history in your case. Be specific and provide examples
  Pharmacology is the study of the interactions between drugs and the body. The two broad divisions of pharmacokinetics refers to the movement of drugs through the body, whereas pharmacodynamics refers to the body’s biological response to drugs. Pharmacokinetics describes the drug’s exposure by characterizing absorption, distribution, bioavailability, metabolism, and excretion as a function of time, while pharmacodynamics describes drug response in terms of biochemical or molecular interactions (Arcangelo et al., 2017). The focus of this discussion will be in the process of warfarin in term of pharmacokinetics and pharmacodynamics of it in the body.   Ms. J.J. ‘s Health issue:   I was in charge of Ms. J. care couple years ago, a 85 year old African American women who was diagnosed with dementia cerebral infarction due to unspecified occlusion of cerebral artery, arthropathy, major depressive disorder, atrial fibrillation with a history of long-term use of anticoagulants, contracture of muscle, constipation, hypertension and GERD. She is currently on coumadin for the atrial fibrillation and the blood levels are monitoring every week in order to control the drugs therapeutic levels and avoid any adverse reactions.  Pharmacodynamics versus pharmacokinetics of this anticoagulant:  Many statistics from the stroke prevention in atrial fibrillation (SPAF) trial suggest that safety of anticoagulant in the elderly can be maximized through a careful monitoring and maintenance of the INR which is between 2 and 3. Ms. J’s therapeutic window for warfarin 2 to 3 which is the normal range for coumadin therapeutic level. Her weekly dosage is adjusted to her current blood levels. Bleeding is the most related complication of anticoagulant. Amy INR that increasing to 3.4 or 4.0 from Ms. J will result in nose bleeding, decreasing the coumadin or stop it for one or two days will be the only option (Horton & Bushwick, 1999).     Factors influencing Ms. J’s drugs therapy:   Multiple factors may affect the absorption of her medication. For example, the presence or the absence of flood in the stomach, blood flow to the area for absorption, and the dosage form of the drug. In Ms. J’s case, the most critical factor. Influencing her absorption of coumadin is gastric motility due to the history of constipation that she has, while a routine laxative dose and stools softens are administered daily for bowel movement.  Patient-centered care plan for management of constipation:   A non-pharmacologic care plan management can be introduced for the constipation in order to reduce the frequency and the quantity of laxative and stool. Softens doses that Ms. J is getting and ultimately gain a net decrease in gastrointestinal absorption of coumadin. Increasing a dietary fiber in her menu, encourage fluid and prune juice can have a significant impact on her bowel movement (Portalatin & Winstead, 2012).     Portalatin, M., Winstead, N. (2012). Medical Management of Constipation. Clinic in Colon and   Rectal Surgery. Doi: 10.1055/s-0032-1301754. Retrieved from   https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3348737/  Horton, J. D., Bushwick, B. M. (1999). Warfarin Therapy: Evolving Strategies in Anticoagulation American Family Physician. 59(3):635-646. Retrieved from   https://www.aafp.org/afp/1999/0201/p635.html     Arcangelo, V. P., Peterson, A. M., Wilburg, V., Reinhold, J. A. (2017). Pharmacotherapeutics for Advanced Practice: A Practical Approach. (4th Ed.). Wolters Kluwer Lippincott Williams &
 

REPLY 1

The best way to handle s situation and to aide Mrs. Faulkenberg’s compliance would be another health care professional apologizing to start. As a rule of thumb, I was taught when working with patients especially elderly Mr. and Mrs. Should be used when addressing them unless told otherwise (Mayne, 2019). If no-one responded when the name was called, then I feel the women should have been asked what her name is or if she is waiting to be seen. The approach just seems uncaring or professional. When calling names out into the waiting room I make sure to ask the patient if I pronounced their name right or if that is what they want to be called out of respect and the fact not everyone goes by their legal name. Making eye contact, a smile while introducing yourself is also important. If someone treated your grandmother like this how would you feel?

There are multiple things to consider as to why Alma Faulkenberger did not respond the way this situation played out. A full assessment should be completed before assuming, the patient also deserves specifics about herself to be asked in a private area. In this specific case I believe asking the patient what she would like to be called would be a great way to show respect and start forming a good patient-health care provider relationship. A bond must be established of trust before there will be a good working relationship. There is no way to even begin to know what this patient is dealing with or experiences she has had with healthcare providers simply approaching with empathy and attempting to listen to the patient can get you far. This patient could be hard of hearing, in pain, dealing with chronic conditions, or just flat out had bad experiences with providers. The other huge consideration could be the patient’s independence. The patient may feel hopeless or may have others making decisions for her and feels all she has left is her name and how dare someone take that. Elderly in general do not like to be told what to do or disrespected who would? I’ve personally had some patients that were resistant to everything just plan angry with life until they are allowed to make decisions and be apart of their care. These people are aging but they should be respected, and the best should still be provided no matter how difficult they are. Once these people see you care you can have a wonderful relationship it is rewarding for all parties.

After an assessment should be a discussion of how the patient is feeling, and what questions she has about the procedure. Everything should be explained slowly. Medications should always be approached by educating the patient but allowing the patient to understand and actively decide whether those medications are a choice the patient wants. This will require a further understanding of the patient’s beliefs as well as goals. The entire patient must be considered. I would get to know the patient and discuss alternative options as well as medications. Then if the patient agrees I would provide education in person as well as with hand outs since it can be a lot of information to remember, small amounts of info at a time is less overwhelming.

Reference:

Farris, C. (2015). The teach back method. Retrieved from https://www.nursingcenter.com/journalarticle?Article_ID=3126832

REPLY2

Alma Faulkenberger, an 85-year-old female outpatient who is seated in a waiting room awaiting an invasive pelvic procedure, has clearly become upset when the health care professional mis-pronounces her name several times. The health care professional further offends her be assuming that, due to her age and the fact that she did not answer to the mis-pronounced name, she must suffer from a hearing impairment. It is important in this instance to take extra care and consideration in ensuring that Alma is compliant with the procedure and post-treatment medications and receives effective patient education. This is necessary as frustrated patients can often become non-compliant, and Alma is clearly upset by the current situation. Furthermore, negative experiences within health care can impact a patient’s health outcomes as they may not seek medical assistance with necessary.

     According to the article How to Facilitate Better Patient Compliance, “several key factors are linked to non-compliance, including social and family relationships, experiences with the health care system and patient perceptions about illness and medication.” For this reason, considerations are necessary such as attempting to understand the patient’s perception of the situation. This includes acknowledging Alma’s feelings and addressing what has made her upset. This will address the issue at hand, thus, clarify any misunderstanding as well as change the negative tone of the encounter. A more positive tone will encourage compliance of the procedure.

     A patient-centered approach should be implemented in order to develop an effective plan of care. This must include patient education in order to ensure compliance with post-treatment medications. Patient-centered approaches in health care highlight the partnership which exists between the patient and the health care professional (Falvo, 2011). Furthermore, this approach ensures that the patient is fully involved in the decision-making process and obtains any information related to their health and wellness. By being fully involved in this process, patients better understand plans of care, as well as medications and treatments. Patient-centered approaches in health care result in compliance and positive patient outcomes. Ultimately, “adherence is a reflection of good communication and a relationship that is built on respect, active participation, and partnership between patient and health professional” (Falvo, 2011). Thus, by addressing what has upset Alma, and implementing a patient-centered approach giving Alma a sense of understanding and control of her health, this will ensure an overall positive outcome is achieved.

References:

Falvo, D. R. (2011). Effective Patient Education: A Guide to Increased Adherence. Retrieved from https://viewer.gcu.edu/RQBKXW

Rothenberg, G. (2003, June 03). How To Facilitate Better Patient Compliance. Retrieved fromhttps://www.podiatrytoday.com/article/1612

In a Microsoft Word document of 4-5 pages formatted in APA 7 style, describe the information collected about a person with a chronic illness (see attachment). Please note that the title and reference pages should not be included in the total page count of your paper.

Using the information from the interview you conducted in Week 2: (see attachment)

• List the support needs of your participant beginning with the highest priority and then in descending order.
• Provide examples of appropriate interventions of the professional caregiver, for example, the nurse.
• Discuss how to implement objectives of Healthy People 2020 to increase wellness.
• Discuss nursing’s role as an advocate for participant acceptance of diagnosis and treatment.
• Discuss the impact of the environment on patient’s health.
  • Include social determinants that impact care.
  • Include a conclusion 

Support your responses with examples and information from library resources, textbook and lectures.

On a separate references page, cite all sources using APA 7 format. 

 Student Course Self-Reflection (Guided Essay)Learners must complete a final applied self-reflection essay on their performance of the course based on the documents and artifacts provided in the performance portfolio. This essay must include at least 5 paragraphs and be limited to a maximum of 2 pages.

1.What have you learned in the course that will help you continue to grow as a professional in your chosen career?

2.Which specific assignment for this course was your best work? Name one. What makes it your best work? What did you learn by creating it? What does it say about you as a student inregards to your degree concentration? How do you plan to use it in your field?

3.In which area(s) will you likely continue to strengthen your knowledge or competencies?

4.Which strategies did you use to learn the material in this course?,Which were the most effective? Why?

5.How did your communication skills improved with this course? Discuss new vocabulary, the style of the profession (writing and oral), others 

 A 52-year-old woman complains that she has been missing days of work almost every week. She states she is neglecting her family, and she is sleeping during the day but cannot sleep at night. She denies other health problems, medication, or environmental allergies. 

• From the information provided, list your differential diagnoses in the order of “most likely” to “possible but unlikely.”

Nur 561 4 replies

Nur 340 2 replies

Nur 495 2 replies 

For  each Barrier to Patient Centered Care, identify facilitators that could  be introduced to balance/offset the barrier. Provide rationale for your  response based on (text books, articles,  practice guidelines, etc) as appropriate:

Barriers:

1. Competing care obligations (patient–load) interfere with prioritizing discussions of discharge planning with patient/planning.
2. Discharge communication ranged from simple one-sided instruction to shared decision making.
3. Patients did not feel prepared for discharge and post-discharge care was not individualized.
4. Discharge process/decisions affected by pressure for available beds.

The purpose of the signature assignment is for students to apply the research and EBP concepts they have learned in this course and develop a framework for the initial steps of the student’s capstone project. The assignment allows the student to initiate the steps for planning, researching and developing an evidence-based practice intervention project proposal. 

This formal paper will include and expand upon work completed thus far in prior assignments.

Essential Components of the Final Project Proposal will include:   

1. Introduction– Provide an introduction to your topic or project. The introduction gives the reader an accurate, concrete understanding what the project will cover and what can be gained from implementation of this project.
2. Overview of the Problem – Discuss the problem,  why the problem is worth exploring and the potential contribution of the proposed project to the discipline of nursing.
3. Project Purpose Statement – Provide a declarative sentence or two which summarizes the specific topic and goals of the project.
4. Background and Significance – State the importance of the problem and emphasize what is innovative about your proposed project. Discuss the potential impact of your project on your anticipated results to the betterment of health and/or health outcomes.
5. PICOt formatted Clinical Project Question(s)– Provide the Population, Intervention, Comparison, Expected Outcomes and Timeframe for the proposed project.
6. Literature Review – Provide the key terms used to guide a search for evidence and discuss at least five (5) summaries of relevant, credible, recent, evidence-based research studies to support the project proposal.
7. Critical Appraisal of Literature – Discuss the strengths and weaknesses of the evidence, what is known from the evidence and what gaps in evidence were found from the appraisal of evidence-based research studies.
8. Develop an EBP Standard – Describe  two to three interventions (or a bundle of care) from the evidence and discuss how individual patient preferences or the preferences of others will be considered.
9. Implications – Summarize the potential contributions of the proposed project for nursing research, education and practice.

Expectations

• Due: 10/22/2020
• Length: A minimum of 8 pages and a maximum of 10 pages (excluding the title and reference pages)
• Format: Formal scholarly paper in APA 6th ed format
• Reference Citations: A minimum of five, recent (past five years), peer-reviewed scholarly references cited in APA 6th ed format.

Family member at times wish that we withhold information from the patient because they might get more ill and depress because of their prognosis. This information should not be withheld from the patient, the patient as a right to know what is going on”. Reflecting on a situation such as this, how would you handle the family’s request to refrain from sharing the patient’s prognosis with them? What is your responsiblity as the bedside nurse and how would you respond?

1 page 1 reference nothing older than 2015 

 ANSWER THE QUESTIONS?

1-FACTOR CAUSING   HEALTHCARE- ASSOCIATED INFECTIONS

 2-RISK FACTOR  OF HEALTHCARE- ASSOCIATED INFECTIONS

 Reference cited in text for each answer and minimum of 2 Scholarly References (Journals, books) no more than 5 years.